Effect of Reflexology on Pain and Pulmonary Function in Patients with Cervical Spondylosis

Transcription

1 Med. J. Cairo Univ., Vol. 84, No. 1, December: , Effect of Reflexology on Pain and Pulmonary Function in Patients with Cervical Spondylosis ZAHRA M.H. SERRY, Ph.D.*; AMIRA M. AFIFY, Ph.D.** and AMANI Z. AL-JAMMALI, M.Sc.* The Departments of Physical Therapy for Cardiopulmonary Disorders & Geriatrics, Faculty of Physical Therapy, Cairo* and 6th of October** Universities, Egypt Abstract Background: Reflexology is a form of complementary medicine techniques that is known to be used in pain management, relief of tension and fatigue, and improving psychological status of patients suffering various conditions. The effect of reflexology on cervical spondylosis chronic pain and related respiratory dysfunction is not yet addressed. Objective: To study the effects of reflexology on pain and ventilatory parameters in patients with cervical spondylosis. Methods: Thirty patients with cervical spondylosis were assigned to Reflexology (RL) group (11 men and 4 women), and control group (11 men and 4 women). Mean age in RL group was ±4.36, and in control group was ±3.37. Patients in both groups were assessed pre-treatment and posttreatment at the end of 4 weeks for pain using Visual Analogue Scale (VAS) and ventilatory function tests that included VC, FVC, FEV 1, and FEV 1/FVC. The reflexology group received 3 sessions/week (45 minutes each) for 3 weeks. Results: Pain significantly improved at postreatment than pre-treatment in RL group. Likewise pain was significantly less than the control group at postreatment assessment. Ventilatory function tests did not show any significant difference neither within groups comparing pre and postreatment assessment nor between groups comparing pre and posttreatment assessments in both groups. Conclusion: Pain intensity but not ventilatory parameters is improved by application of reflexology in patients with cervical spondylosis. Key Words: Reflexology Pain Ventilatory function tests Cervical spondylosis. Introduction CERVICAL spondylosis refers to a degenerative disorder of the spine that involves the intervertebral discs and vertebrae at multiple levels [1]. Cervical Correspondence to: Dr. Zahra M.H. Serry, The Department of Physical Therapy for Cardiopulmonary Disorders & Geriatrics, Faculty of Physical Therapy, Cairo University, Egypt spondylosis is the most common cause dysfunction in the elderly [2]. As the condition progress the patient can develop cervical radiculopathy and myelopathy. Cervical spondylosis is considered the most common cause of non-traumatic cervical myelopathy [2]. Radicular symptoms is the result of nerve compression and manifests in the distribution of the involved nerve root (s). Sensory manifestations include numbness, tingling, or burning sensations [3]. Patients with cervical pain have several pathophysiological and mechanical factors that may cause them to develop respiratory dysfunction which include weakness of deep neck flexors and extensors, hyperactivity of superficial neck flexors, pain that patient psychological status, limited neck mobility, and proprioception [4]. Specially pain associated with kinesiophobia tends to be an important cause of respiratory dysfunction in patients with chronic neck pain [5]. Recent studies reported reduced maximal inspiratory and expiratory pressure, vital capacity, FVC, expiratory reserve volume along with reduced Maximal Voluntary Ventilation (MVV), in patients with chronic neck pain. This respiratory dysfunction is associated with isometric strength defects in neck muscles and postural dys-function in form of forwards head posture [4-6]. Reflexology is generally considered a form of complementary and alternative medicine used in addition to conventional medical care or standalone [7]. Reflexology practice is not a new therapy, albeit it is has historical evidences and appeared in different age and cultures from East to West. It was applied by Chinese, Egyptians and North American and Indian tribes [8]. It is broadly defined as applied pressure to given areas of the body specially in the hands and feet to promote effects 1277

2 1278 Effect of RL on Pain & Pulmonary Function in Patients with Cervical Spondylosis in other parts of the body [8]. The application of reflexology in painful conditions of the spine is diverse and conflicting in literature. While some studies reported positive effects of reflexology in relieving back pain [9,10], others reported no significant effects of reflexology over usual care in treating low back pain [11]. There we are not aware of any previous studies neither examined the effects of the application of reflexology in managing of pain in cases of cervical spondylosis nor how reflexology in for such conditions may affect associated respiratory dysfunction. Therefore, the aims of this study were to assess the effect of reflexology on pain intensity experienced in patients with cervical spondylosis. Furthermore, to check for improvement in respiratory dysfunction in patients with cervical spondylosis as a consequence of application of reflexology if any. Subjects and Methods A pre-post experimental control group study was conducted. Thirty patients (22 men and 8 women) suffering cervical spondylosis were randomly assigned to one of the study two equal numbered groups. Reflexology group (RL group) had 11 men and 4 women, age (59.93 ±4.36) and control group had 11 men and 4 females, age (57.66 ±3.37). Patients were included in the study if they had cervical pain over last 6 month and occurring at least once a week [6,12,13]. Patients were excluded from the study if they have recent or healing fractures in foot or with unhealed wounds, immediately prior to surgery, directly after surgery, severe circulation problems in the legs or feet, contagious/ acute infection is present and pregnant women, and if their ventilatory volumes at pre-treatment assessment were above the predicted s. The study procedures were conducted at hospital of University 6 October during 2015, and ethical approval was taken from the institutional ethical committee of scientific research prior to conduction of the procedures. Patients who were illegible for inclusion had complete explanation of the objectives of the study and the procedures, and they signed an informed consent form prior to participation in the study. Procedures: Evaluation procedure: All patients in both RL and control groups conducted the same pre and post experimental evaluation procedures. One examiner conducted the evaluation procedures for all patients. Evaluation procedures started by taking patients personal data and recording height and weight. Pain assessment: The examiner explained to the patient how to identify the pain intensity in Visual Analogue Scale (VAS). VAS is a measurement for pain intensity, and its validity and reliability for pain measurement was reported in literature [14]. VAS is a 10cm line marked at the left end no pain and at the right end worst imaginable pain [14]. The patient was asked to make a mark that express his pain intensity. The length of the line from the left end to the patient's mark is measured and recorded in cm. Ventilatory function tests: The testing of Ventilatory Function (VF) was conducted using discovery spirometer (Futuremed America. Inc., CA, USA). In preparation to testing patients were asked to stop any medical treatment, stop smoking for at least 4 hours, fast for at least 2 hours to avoid vomiting or any form of gastric distress, and to avoid any vigorous effort immediately prior to testing [15,16]. Patients were asked not to wear tight clothes during testing as this might negatively affects the readings at the beginning of the assessment patient was a seated in a comfortable position [15]. Patients nose were closed by a nose clip to prevent the patient from breathing through his/her nose during testing. A disposable rubber mouth piece is used, and the examiner asked the patient to close his/her lips tightly around the mouth piece. The patient took few breathe in and out through the mouth piece then inhaled maximally and exhaled forcefully for as long as he or she could [15,16]. Then the parameters under investigations (VC, FVC. FEV 1 ) were directly recorded and FEV 1 /FVC automatically calculated and reported. Treatment procedure: Patients in the control group took the pre experimental assessment, and they were scheduled for post experimental assessment at the end of 4 weeks period. Patients in RL received treatment for 3 sessions per week for 4 weeks. Sessions of the patients in RL group lasts for 45 minutes (half the time for each foot starting with the right then the left foot). Patient assumed relaxed supine lying position with the heels of both feet outside the foot edge of the plinth and removed the shoes and socks. The therapist was seated at the foot edge of the plinth to gain easy grasp and control of the patient's feet. Therapist inspected the feet for any cuts or broken skin, and inspected the toes and nails for any possible skin allergy or infection. The feet were cleaned with a disinfectant wipe. Therapist hands supported the sole of the foot while the thumb walk from the base of the big toe, this is the same zone on both feet that stimulate the cervical spine [17,18].

3 Zahra M.H. Serry, et al Results Thirty patients with cervical pain were included in 2 equal-numbered groups namely control group included 11 males and 4 females, also reflexology group also included 11 males and 4 females, no significant differences were detected between control and experimental groups in demographic variables (Table 1). Within groups comparisons of pre and post experimental mean s of pain, VC, FVC, FEV 1, and FEV 1 /FCV were conducted. In the control group there was no significant difference in mean pain intensity at postreatment evaluation compared to pre-treatment evaluation ( p=0.175) Fig. (1). On the other hand, mean pain intensity was significantly reduced at post experimental evaluation compared to pre experimental evaluation in reflexology group (p=0.000) Fig. (1). Ventilatory parameters mean s did not differ significantly in either control or reflexology groups between pre and post experimental evaluations (Table 2). The results of pre-experimental comparisons between patients in control and reflexology groups in all test outcomes showed non-significant differences in pain intensity (p=0.829) Fig. (2), and Ventilatory parameters (VC, FCV, FEV 1, and FEV 1 / FVC) (Table 3). Postreatment comparison of mean s of pain intensity between patients in control and reflexology groups showed significant lower pain intensity in patients of reflexology group compared to control group (p=0.000) Fig. (2). On the other hand no significant differences were detected between patients in both groups post experimentally concerning any of the ventilatory parameters (Table 3). Table (1): Comparative analysis of the mean s of patients demographic data between control and RL groups. Groups Characteristics Age (years) Weight (Kg) Height (cm) BMI (kg/m 2 ) *: p<0.05. Control group 57.66± ± ± ± 1.49 RL group 59.93± ± ± ± Table (2): Comparison of the means of VC, FVC, FEV 1, and FEV 1 /FVC between patients pre and post experimental evaluations in both RL and control groups. Control group RL group Variables Pre Post Pre Post VC 2.70 (± 1.05) 2.73 (±0.97) (± 1.09) 2.34 (± 1.15) FVC 1.96 (±0.79) 2.05 (±0.77) (± 1.09) 3.03 (±2.63) FEV (±0.21) 1.58 (±0.25) (±0.41) 1.44 (±0.41) FEV 1 /FVC (± 18.41) (± 19.43) (±32.51) (±28.29) *: p<0.05. Table (3): Comparison of the means of VC, FVC, FEV 1, and FEV 1 /FVC between patients in control and RL groups at pre and post experimental evaluations. Pre experimental Post experimental Variables Control RL Control RL VC 2.70 (± 1.05) 2.28 (± 1.09) (±0.97) 2.34 (± 1.15) FVC 1.96 (±0.79) 2.14 (± 1.09) (±0.77) 3.03 (±2.63) FEV (±0.21) 1.42 (±0.41) (±0.25) 1.44 (±0.41) FEV 1 /FVC (± 18.41) 60 (±32.51) (± 19.43) (±28.29) *: p<0.05.

4 1280 Effect of RL on Pain & Pulmonary Function in Patients with Cervical Spondylosis Control group Reflexology group 0 Pre-treatment Postreatment Pre-treatment Postreatment Control group Reflexology group Fig. (1): Comparison between means of pain intensities at pre-experimental and posexperimental evaluations in both control and RL groups. Fig. (2): Comparison of mean s of pain between control and RL groups at pre and post experimental evaluations. Discussion The results of the current study showed that reflexology was effective in pain management of the patients with cervical spondylosis as compared to controls. On the other hand, there was no significant difference between the effects of reflexology and control in any of the tested ventilatory parameters (VC, FVC, FEV 1, FEV 1 /FVC). Pain management: The results of the current study reported improvement of pain with cervical spondylosis using reflexology technique applied to the foot in the reflex zone of the neck. To our best knowledge the effect of reflexology on cervical spondylosis and other forms of neck dysfunctions that might cause neck pain is not reported in previous studies. However, application of reflexology on the spine in cases of low back pain was investigated earlier. A randomized controlled trial conducted to test the effects of reflexology on LBP compared to relaxation and control groups. They conducted their study on a total of 243 patients with chronic LBP, and results showed that there was no significant difference in pain control between the three groups, although there was a trend of better pain improvement in results of reflexology group [11]. These results contradict the results obtained in the present study but likely sources of difference sounds obvious due to the difference of the treated region. In addition, in the LBP study they had 5 different therapists conducted reflexology treatment with no standard procedures, each of them used his/her own experience, and treatment was once weekly for 6-8 weeks. In the current study a single therapist conducted the procedures in the same way and for 12 sessions over 4 weeks. This may likely provided more significant results in pain reduction. A study conducted to check for the effect of reflexology on LBP compared to standard medical treatment, results found that reflexology combined with medical treatment improved pain significantly, but it was not significantly better than medical treatment alone given in the other group [10]. However, the sample size in this study was small. So results, showing positive trend in favor of reflexology group, could had shown more clear indicator with larger sample sizes. Likewise, a pilot study which investigated the effects of reflexology on pain control in patients with LBP found that reflexology group had significant pain reduction compared to sham treatment. Although sample size was small to draw any statistical significance, authors reported that their results were promising as median reduction in VAS was 2.5 indicating possibility of achieving significance in larger sample size studies [9]. The mechanism how reflexology likely reduces pain is based on gate control theory of pain. According to the theory tactile stimulation of the reflex zone possibly stimulate A beta sensory fibers that blocks the transmission of pain signals through blocking transmission at the dorsal horn of the spinal cord [19]. Reflexology may work by stimulating the body to release pain relieving chemicals, endorphins, and in this way may help to reduce pain and increase feelings of wellbeing and relaxation [7,20,21]. Ventilatory function tests: In present study there is no significant difference within RL groups and control group pre-treatment

5 Zahra M.H. Serry, et al and postreatment on the Ventilatory function tests. Likewise, there was no significant difference between RL and control groups either pre- treatment or postreatment. To the best knowledge of the authors the effect of reflexology on Ventilatory functions have not been tested in patients with cervical spondylosis. Ventilatory function tests were assessed in cases of chronic neck pain and several parameters were reported to be affected such as VC, FVC, and MVV [5,6,12,13]. Among the reported causes behind respiratory dysfunction were suggested to be fatigue and hyperactivity of neck flexor muscles, pain, and psychosocial effects of chronic neck pain [12]. Neck pain, kinesiophobia, and fatigue and weakness of neck muscles were found correlated to respiratory dysfunction [5]. Pain, neck muscles tension and fatigability due to hyperactivity, and psychological factors such as kinesiophobia could be improved by the application of reflexology on the related reflex zone [8,22,23]. In the current study, reflexology showed better pain reduction over control condition, while we cannot comment on the other 2 factors, namely neck muscles relaxation and psychological factors as these were not directly measured in the current study. Pain reduction purse as an effects of reflexology have not resulted in significantly positive changes in ventilatory function testing. It is unclear whether reflexology as a single treatment is sufficient to result in significant enhancement of ventilatory functions. Accordingly, we suggest it is better to include reflexology with other physical therapy approaches that enhances ventilatory function in a combined program. Another factor that the mean s of ventilatory parameters in this study were considered compared to normative mean s drawn from European population based on subject's age and height. We are unaware of normative mean s of ventilatory parameters drawn from our population. European population might vary from our population in normative mean s of ventilatory parameters as several factors were reported to be source of variation between different populations such as trunk length relative to standing height, lung size, and chest dimensions [24]. Accordingly, it is likely that means of ventilatory parameters in the current study may be within normal in our population, and reflexology would unlikely improve them further. Therefore, we recommend conducting wide scale investigation to identify normative mean s of ventilatory parameters from our population. Conclusion: Reflexology as applied in the present study showed significant improvement in pain in patients with cervical spondylosis. On the contrary, despite showing higher percentage of improvement in ventilatory parameters than control group, reflexology did not achieved statistically significant improvement in any of those parameters. References 1- SINGH S., KUMAR D. and KUMAR S.: Risk factors in cervical spondylosis. Journal of clinical orthopaedics and trauma, 5 (4): P , TAKAGI I., ELIYAS J.K. and STADLAN N.: Cervical spondylosis: An update on pathophysiology, clinical manifestation, and management strategies. Disease-amonth: DM. 57 (10): P. 583, ROTH D.: Cervical radiculopathy. Dis. Mon., 55 (12): P , KAPRELI E., VOURAZANIS E. and STRIMPAKOS N.: Neck pain causes respiratory dysfunction. Medical Hypotheses, 70 (5): P , DIMITRIADIS Z., KAPRELI E., STRIMPAKOS N. and OLDHAM J.: Pulmonary function of patients with chronic neck pain: A spirometry study. Respir. Care, 59 (4): P , DIMITRIADIS Z., KAPRELI E., STRIMPAKOS N. and OLDHAM J.: Respiratory weakness in patients with chronic neck pain. Man. Ther., 18 (3): P , MCCULLOUGH J.E., LIDDLE S.D., SINCLAIR M., CLOSE C. and HUGHES C.M.: The physiological and biochemical outcomes associated with a reflexology treatment: A systematic review. Evid Based Complement Alternat. Med., (10): P. 5, BOTTING D.: Review of literature on the effectiveness of reflexology. Complementary Therapies in Nursing and Midwifery, 3 (5): P , QUINN F., HUGHES C.M. and BAXTER G.D.: Reflexology in the management of low back pain: A pilot randomised controlled trial. Complement. Ther. Med., 16 (1): P. 3-8, GLIGOR Ş. and ISTRATE S.: Aspects Regarding the Beneficial Effect of Reflexology in Low Back Pain. Timisoara Physical Education and Rehabilitation Journal, 5 (10): P. 43-8, POOLE H., GLENN S. and MURPHY P.: A randomised controlled study of reflexology for the management of chronic low back pain. Eur. J. Pain, 11 (8): P , KAPRELI E., VOURAZANIS E., BILLIS E., OLDHAM J.A. and STRIMPAKOS N.: Respiratory dysfunction in chronic neck pain patients. A pilot study. Cephalalgia, 29 (7): P , WIRTH B., AMSTALDEN M., PERK M., BOUTELLIER U. and HUMPHREYS B.K.: Respiratory dysfunction in patients with chronic neck pain-influence of thoracic spine and chest mobility. Man. Ther., 19 (5): P , 2014.

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